Evaluation of piezoelectric surgery in combination with platelet-rich fibrin for treatment of medication-related osteonecrosis of the Jaw

Abstract

Purpose To evaluate the effect of piezo debridement with application of platelet-rich fibrin (PRF) on bone and soft tissue healing in patient with medication-related osteonecrosis of the jaw (MRONJ), both clinically and radiographically. Patients and methods At the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Tanta University, a prospective noncontrolled clinical study was carried out on eight patients above 30 years old who are proved to have MRONJ clinically and radiographically. Preoperatively, (ampicillin/sulbactam) with a dosage of 1.5 gm vial IV or IM and (doxycycline) 100 mg/capsule once daily were prescribed for all patients one week before surgery. Intraoperative, after surgical exposure of the affected bone, Surgery divided into resecting all the infected and necrotic bone with the piezoelectric vibrating tips connected to the piezoelectric bone surgery device until bleeding spots appear. Autologous PRF was applied, followed by double layer closure of the flap. All patients had postoperative, clinical evaluation of pain, wound healing and recurrence. Lab investigation, including CBC, ESR, C reactive protein was carried out for all patients. Radiographic evaluation was done using Cone Beam Computed Tomography (CBCT) after one-week and after 3 months postoperatively. Results In the first 2 weeks, most patients had complete relief of pain and swelling. Complete healing of the soft tissue was observed in five patients showing normal range of ESR and CRP, and three patients showed partial soft tissue healing and signs of recurrence clinically and radiographically. These findings shown that using piezo debridement combined with PRF has a positive effect on bone and soft tissue healing in patient with MRONJ. Conclusion Piezoelectric bone surgery in combination with PRF is an alternative treatment method in treatment of MRONJ as it provides minimally invasive surgical technique, effective in complete debridement of affected bone tissue and soft tissue.